Healthcare Provider Details

I. General information

NPI: 1508041617
Provider Name (Legal Business Name): STEPHAN Z BORBELY DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 BOULEVARD
ELMWOOD PARK NJ
07407
US

IV. Provider business mailing address

511 BOULEVARD
ELMWOOD PARK NJ
07407
US

V. Phone/Fax

Practice location:
  • Phone: 201-703-3330
  • Fax: 201-703-3332
Mailing address:
  • Phone: 201-703-3330
  • Fax: 201-703-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number0954280001
License Number StateNJ

VIII. Authorized Official

Name: STEPHAN Z BORBELY
Title or Position: OWNER
Credential: DPM
Phone: 201-703-3330